A new study from Cardiff University has found that perimenopause, the transitional period leading up to menopause, may significantly increase the risk of certain psychiatric disorders. The research, involving over 128,000 women, sheds light on how hormonal changes during this stage can affect mental health, particularly the first onset of mania and major depressive disorder (MDD). The findings were published in the journal Nature Mental Health.
Lisa Shitomi-Jones and her team at the Centre for Neuropsychiatric Genetics and Genomics led the study’s analysis of data from the UK Biobank, a sizable biomedical database. Researchers discovered that during the perimenopausal phase, women were at a heightened risk of experiencing psychiatric disorders compared to their premenopausal years. The findings are particularly striking for disorders such as mania, with rates more than doubling during this period.
For decades, it has been well understood that perimenopause brings a variety of physiological changes, from hot flushes to mood swings. However, this new study goes further by providing robust data linking reproductive ageing with the onset of severe mental health conditions. While depression has long been associated with hormonal changes in midlife, the link to disorders like mania has not been widely recognised until now.
One of the most surprising findings of the study was the dramatic increase in cases of mania during perimenopause. While major depressive disorder saw a 30% rise in new diagnoses during this period, mania’s incidence more than doubled. This is a significant development, as mania, a hallmark symptom of bipolar disorder, has traditionally been associated with younger populations, particularly those in their twenties or thirties. The data revealed that women with no prior history of psychiatric illness were over twice as likely to develop mania during perimenopause compared to the years leading up to this phase.
Ian Jones, co-author of the study, noted, “This increase in mania is something that hasn’t been observed before at this scale. The findings emphasise the need for heightened awareness among healthcare professionals during this crucial phase of reproductive ageing.”
The study’s authors suggest that the hormonal fluctuations characteristic of perimenopause could be a driving factor behind these psychiatric risks. Estradiol, a form of oestrogen, plays a key role in regulating mood, and its levels begin to fluctuate significantly during perimenopause. Previous research has linked these hormonal shifts to mood disorders, but the precise mechanisms remain unclear.
George Kirov, another member of the research team, explained, “While we’ve seen the impact of hormonal changes postpartum, perimenopause represents a similarly vulnerable period for women’s mental health. This makes sense, given the drastic changes in hormone levels that occur.”
The study found no significant association between perimenopause and schizophrenia spectrum disorders. In fact, the rates of schizophrenia onset slightly decreased in the postmenopausal stage, a finding that challenges previous assumptions about the role of oestrogen in protecting against psychosis.
These findings have far-reaching implications for how mental health is managed in women approaching menopause. The study’s authors argue that clinicians need to be aware of the heightened risk of psychiatric disorders, particularly mania and MDD, in perimenopausal women. Misdiagnosing mania as depression, for instance, could lead to inappropriate treatments that worsen the condition.
